11/14/2025
Case Study: Ventral displacement (spondylolisthesis) revealed only in upright MRI
A 65-year-old female patient had longstanding lumbar spine complaints (radiating thigh pain, worse with activity). Her conventional supine MRI showed no clear cause.
Upright-MRI
She underwent an upright (weight-bearing) MRI examination in sitting/standing positions. In the upright imaging, a ventral displacement (anterolisthesis) of the L4 vertebral body relative to L5 was clearly visible—which had not been detectable in the supine images.
The upright MRI also showed a decrease in the ventrodorsal diameter of the spinal canal at that level under load—revealing spinal canal narrowing during weight-bearing which was not apparent in the supine scan.
Based on this imaging finding, the treating physician had clearer evidence of a structural cause of the patient’s symptoms and was able to plan appropriate intervention. The conclusion: the upright MRI added critical diagnostic information.
Why this is a useful example
It demonstrates that symptom-provoking positions (standing/sitting/under load) can reveal pathology (here anterolisthesis + stenosis) invisible in the supine/resting posture.
It provided actionable clinical information: the uncovering of a dynamic/spinous instability allowed for better targeted treatment.
It reinforces the concept that upright MRI isn’t just “more scan time” but can change diagnosis and management.
